Finnish and Swedish researchers have discovered that sufferers of diabetes can be classified into five groups, depending on their diabetic symptoms and the complications that arise from them. Diabetes – a group of metabolic imbalances that can be characterized by high blood sugar levels over a prolonged period of time – is usually split into Types 1 and 2.

The report suggests that whereas Type 1 diabetes is clearly associated with auto-immune deficiencies, Type 2 appears to be “highly heterogeneous,” leading the researchers to identify four new subtypes, each with statistically clear distinguishing features in symptoms and complications, ranging from kidney to retinal problems.

“This new substratification might eventually help to tailor and target early treatment to patients who would benefit most, thereby representing a first step towards precision medicine in diabetes,” said the report.

Dr. Victoria Salem told the BBC that the study was a step forward for diabetes treatment but that it wouldn’t lead to a change in practice just yet. Dr. Salem is a consultant and clinical scientist at Imperial College London.

The study was based on data from 14,775 Scandinavians; the authors make clear in their paper that the applicability of these subtypes to other ethnic groups requires further investigation.

Equally, whilst the researchers acknowledge that this may not yet be the optimum level of classification, it does already appear to be superior to the classic binary Type 1 vs. Type 2 distinction. A web-based tool for assigning patients to one of these subgroups is under development. The study was conducted by Lund University Diabetes Centre in Sweden and Finland’s Institute for Molecular Medicine. The report has been published in The Lancet Diabetes and Endocrinology (paid content).

Current diabetes classification into type I (general early onset) and type II (late onset) diabetes has generally meant similar treatment and thus perhaps, in the case of Type II diabetes, not the most optimal outcome.

Furthermore, a majority of diagnoses are based on a single test and on age of presentation. The prognosis of high risk complications has often been mistakenly limited to type I diabetes while all type II diabetes patients are often seen to have a lesser risk and prognosis and thus are given a similar treatment modality.
The new study, which re-classifies diabetes into 5 types or clusters based on six characteristics, shows distinct differences between the severity of complication risks which in turn may suggest, potential treatment adjustments and prognosis.

It identifies 2 new types of diabetes (that previously would have been within the current type II classification) with high risk and severity that would indicate the need for earlier, more intensive treatment rather than waiting for complications to appear. It also seems to indicate that some patients may have had better results if treatment medications were differently prescribed.

This initial classification and resulting risk assessment correlations in one group of newly diagnosed diabetes patients was replicated in 3 other groups of diabetes patients and not present in a control group of non-diabetic patients. Although most study participants were of Scandinavian ethnicity, and thus the results may not be true for all peoples, the study questions the rational for continuing to rely on the 2 classification system currently in use and suggest more studies. Meanwhile, individual evaluation of current diabetes patients might cautiously suggest changes in treatment especially if they appear to be in the new, higher risk clusters. The study authors indicate that a web based application to help new study developers and possibly clinicians separate patients into appropriate cluster definition is in development.

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